我国约有76%的老年人患慢性病，其中共病（两种及以上）患者达6300万。老年人共病带来了多重用药风险，会引发健康损害、增加疾病负担。但由于老年人及其家庭对多重用药风险认知不足、社区医生应对技能缺乏、医院医生专科化服务理念较重等，导致老年人多重用药风险加剧。国外研究提示，提供“纵向转诊联动、横向专业协同”、“以老年人为中心”的风险管理模式，将有效降低老年人多重用药风险。因此，为减轻老年人健康损害和疾病负担，本研究拟在家庭医生制度背景下，综合运用新制度主义理论和社会网络分析等视角和方法，首先，分析老年人多重用药风险及其形成机制；其次，研制基于家庭医生制度的老年人多重用药风险管理实现路径；最后，构建以“老年人为中心—家庭医生为枢纽”、“不同机构纵向联动—不同专业横向协同”的老年人多重用药风险管理模式，通过实证验证评估模式效果并进行优化。为降低我国老年人用药风险，保障老年人用药安全提供参考和借鉴。

About 76% of the elderly in China are suffering from chronic diseases, including more than 63 million suffering from multimorbidity (two or more diseases). Multimorbidity brings the risk of polypharmacy for the elderly, resulting in health damage and an increased disease burden. However, the elderly and their families are less aware of the risk, the community doctors are lack of coping skills, the specialist often with specialized service concept deeply, which lead to the increased risk of polypharmacy. Studies from abroad have recommended an “elderly-centered”, “longitudinal referral linkage, horizontal professional collaboration” management model, which may effectively reduce the risk of polypharmacy. Therefore, in order to reduce the health damage and disease burden in the elderly, this study intended to comprehensively use the new institutionalism theory and social network analysis based on the family doctor system, to carry out the following works: firstly, analyze the risk of polypharmacy and its formation mechanism; secondly, develop a realizable pathway of managing the risk of polypharmacy in the elderly based on the family doctor system；eventually, construct a polypharmacy risk management model for the elderly, with the themes of “the elderly as the center, the family doctor as the hub” and “vertical linkage of different institutions, horizontal coordination of different specialties”, and evaluate the effectiveness of the model through empirical verification, so as to optimize the model, reducing the drug-induced risk and safeguarding medication safety for the elderly in China.